Spinal manipulative therapy, Graston technique® and placebo for non-specific thoracic spine pain: a randomised controlled trial
One page on PainSci cites Crothers 2016: Tissue Provocation Therapies in Musculoskeletal Medicine
PainSci notes on Crothers 2016:
This study bills itself as the first “fully powered randomised controlled trial comparing spinal manipulative therapy, Graston technique® and a placebo,” which is a fair claim to the best of my knowledge. Graston has barely been studied at all, and although SMT for neck and back pain has been studied quite a bit, not so for the thoracic spine. This makes it a valuable addition the scanty scientific literature on these treatments.
The experiment was fairly careful, large (143 patients), and long term (a year). Disability and pain were the primary outcomes. The results were resoundingly negative: everyone got slowly better, whether they received SMT, Graston, or a placebo.
Although these results cannot be reliably extrapolated to neck and lower back pain, they are probably relevant.
(Dr. Edzard Ernst cooked up some more detailed commentary about this study.)
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: Few controlled trials have assessed the efficacy of spinal manipulative therapy (SMT) for thoracic spine pain. No high quality trials have been performed to test the efficacy and effectiveness of Graston Technique® (GT), an instrument-assisted soft tissue therapy. The objective of this trial was to determine the efficacy of SMT and GT compared to sham therapy for the treatment of non-specific thoracic spine pain.
METHODS: People with non-specific thoracic pain were randomly allocated to one of three groups: SMT, GT, or a placebo (de-tuned ultrasound). Each participant received up to 10 supervised treatment sessions at Murdoch University chiropractic student clinic over a 4 week period. The participants and treatment providers were not blinded to the treatment allocation as it was clear which therapy they were receiving, however outcome assessors were blinded and we attempted to blind the participants allocated to the placebo group. Treatment outcomes were measured at baseline, 1 week, and at one, three, six and 12 months. Primary outcome measures included a modified Oswestry Disability Index, and the Visual Analogue Scale (VAS) «pain scale». Treatment effects were estimated with intention to treat analysis and linear mixed models.
RESULTS: One hundred and forty three participants were randomly allocated to the three groups (SMT=36, GT=63 and Placebo=44). Baseline data for the three groups did not show any meaningful differences. Results of the intention to treat analyses revealed no time by group interactions, indicating no statistically significant between-group differences in pain or disability at 1 week, 1 month, 3 months, 6 months, or 12 months. There were significant main effects of time (p<0.01) indicating improvements in pain and disability from baseline among all participants regardless of intervention. No significant adverse events were reported.
CONCLUSION: This study indicates that there is no difference in outcome at any time point for pain or disability when comparing SMT, Graston Technique® or sham therapy for thoracic spine pain, however all groups improved with time. These results constitute the first from a fully powered randomised controlled trial comparing SMT, Graston technique® and a placebo.
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Specifically regarding Crothers 2016:
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomised trials. Wang 2025 BMJ.
- Gabapentinoids and Risk of Hip Fracture. Leung 2024 JAMA Netw Open.
- Classical Conditioning Fails to Elicit Allodynia in an Experimental Study with Healthy Humans. Madden 2017 Pain Med.
- Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. Kirwan 2024 Br J Sports Med.
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.